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Understanding the Treatment Options for Chronic AFib

The heartbeat is like an orchestra conductor, keeping time and pace with your daily activity. Your organs are like the musicians, all playing perfectly in sync with each other to create beautiful sound. Atrial fibrillation (AFib) causes that timing to flutter and skip. When this happens repeatedly, your internal orchestra will struggle. We spoke with Shane Rowan, MD, a cardiac electrophysiologist at Banner Health in Colorado, to gain a better understanding of AFib and how it can be treated.

How dangerous is AFib?

“In cases involving AFib, I see three different types of patients,” explained Dr. Rowan. “Some patients feel palpitations, or a sensation of an abnormal heartbeat. Others do not feel palpitations, but they know that something is wrong. They may be out of breath or more fatigued than usual, but they don't know it's related to the heart until we identify the problem. Finally, there is a large group of patients that do not have any symptoms from atrial fibrillation - this is a mixed blessing:  it doesn't bother them, but sometimes the first sign of atrial fibrillation can be a stroke in this population.

In addition to the risk of stroke, atrial fibrillation has been associated with an increased risk of dementia. Notably, blood thinners may help to protect against this. Uncontrolled atrial fibrillation can lead to heart failure, trouble breathing and fluid retention. It’s vital to maintain your regular visits with your doctor and to mention any abnormal feelings you may be experiencing.

How is AFib treated?

Dr. Rowan commented, “There are many potential treatments for atrial fibrillation. Determining which one is right for a particular person is a complex decision that is based on many factors including other medical conditions, age, condition, and personal preference.” Your treatment is something that you will work out with your physician. The risk that your AFib presents to your body will be a key decider in how aggressively you pursue relief. Dr. Rowan explained that “there is fairly minimal risk with basic heart rate controlling medications, a bit of increased risk and need for more intensive monitoring with medications to maintain the heart in rhythm, moderate risk with ablation (1-2% risk of complications), and significant risk with hybrid and surgical ablation (5-10% risk of complications).”

Medicinal Treatment

AFIb medications generally fall under two categories: blood thinners to decrease risk of stroke and medication to control your heart rate and decrease abnormal fibrillations. Especially when AFib is found early, these medications can be very effective. Although, there are a few side effects that patients should be aware of. Anticoagulants (blood thinners) can increase your risk of dangerous bleeding, even in minor wounds.

Ablation Treatment

In cases where medication cannot fully resolve the fibrillations, ablation can be effective. A small catheter will be inserted to investigate the areas of your heart which are producing “extra” electrical activity. These areas will then be strategically scarred to eliminate the electricity, leaving only normal currents. This is a minimally invasive procedure which generally requires a shorter recovery time.

Surgical Treatment

Dr. Rowan described a hybrid or convergent ablation procedure that combines ablation on the outside of the heart with the minimally invasive ablation treatment using the catheter, as described above.

Choosing the right treatment

“How aggressive of a treatment to consider depends on how much atrial fibrillation is affecting a person's day-to-day life, how healthy they are otherwise, and what the relative risks/side effects of treatments might be in that person. A young person with no other medical issues might move quickly to an ablation to avoid the need for long term medications. An older person who already needs medication for blood pressure control might be able to use those same medications to control atrial fibrillation symptoms without needing more invasive procedures,” advised Dr. Rowan.

Your body’s orchestra requires perfect timing to create its beautiful music. Even if you haven’t felt symptoms yet, you could be at risk. To learn more about your heart’s health, AFib and get answers to your questions, speak with your primary care physician or visit to take a free heart risk assessment test and find a doctor near you.

Heart Health Senior Health